Zlibut Alexandru, Bietenbeck Michael, Agoston-Coldea Lucia
Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Muenster, 48149 Münster, Germany.
J Cardiovasc Dev Dis. 2025 Sep 4;12(9):340. doi: 10.3390/jcdd12090340.
Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous myocardial disease associated with variable progression and an increased risk of major adverse cardiovascular events (MACEs). Cardiovascular magnetic resonance (CMR) allows the comprehensive evaluation of myocardial structure, function, and fibrosis. This prospective study aimed to assess the prognostic value of CMR-derived global longitudinal strain (GLS) and left ventricular (LV) torsion in patients with DCM.
We prospectively enrolled 150 patients with newly diagnosed non-ischemic DCM and 100 age- and sex-matched healthy controls. All participants underwent standardized CMR protocols including cine imaging, late gadolinium enhancement (LGE), and feature-tracking analysis for myocardial deformation. LV volumes, ejection fraction (LVEF), GLS, and LV torsion were quantified. The primary endpoint was the first occurrence of MACE, defined as cardiac death, sustained ventricular arrhythmia, or heart failure hospitalization. The median follow-up was 33 months.
Compared to controls, DCM patients had significantly impaired LV function and myocardial mechanics: lower LVEF (35.1% vs. 65.2%, < 0.001), reduced GLS (-9.2% vs. -19.7%, < 0.001), and diminished LV torsion (1.04 vs. 1.95 °/cm, < 0.001). GLS ≤ -8.6% was independently associated with increased MACE risk (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 1.01-1.61; < 0.01). Similarly, reduced LV torsion predicted adverse events (adjusted HR: 1.37; 95% CI: 1.03-1.81; < 0.01). The presence of LGE (42% of patients) further stratified risk (HR: 2.86; 95% CI: 1.48-12.52; < 0.001).
CMR-derived GLS and LV torsion are strong, independent predictors of adverse outcomes in DCM. Their integration into routine imaging protocols enhances risk stratification beyond conventional metrics such as LVEF and LGE. These findings support the use of myocardial deformation analysis in the comprehensive evaluation of patients with DCM.
非缺血性扩张型心肌病（DCM）是一种异质性心肌疾病，其病程进展不一，主要不良心血管事件（MACE）风险增加。心血管磁共振成像（CMR）可对心肌结构、功能和纤维化进行全面评估。这项前瞻性研究旨在评估CMR衍生的整体纵向应变（GLS）和左心室（LV）扭转对DCM患者的预后价值。
我们前瞻性纳入了150例新诊断的非缺血性DCM患者和100例年龄及性别匹配的健康对照者。所有参与者均接受了标准化的CMR检查方案，包括电影成像、延迟钆增强（LGE）以及心肌变形的特征追踪分析。对左心室容积、射血分数（LVEF）、GLS和左心室扭转进行了量化。主要终点是首次发生MACE，定义为心源性死亡、持续性室性心律失常或因心力衰竭住院。中位随访时间为33个月。
与对照组相比，DCM患者的左心室功能和心肌力学明显受损：LVEF较低（35.1%对65.2%，<0.001），GLS降低（-9.2%对-19.7%，<0.001），左心室扭转减少（1.04对1.95°/cm，<0.001）。GLS≤-8.6%与MACE风险增加独立相关（调整后的风险比[HR]：1.09；95%置信区间[CI]：1.01-1.61；<0.01）。同样，左心室扭转减少预示着不良事件（调整后的HR：1.37；95%CI：1.03-1.81；<0.01）。LGE的存在（42%的患者）进一步分层了风险（HR：2.86；95%CI：1.48-12.52；<0.001）。
CMR衍生的GLS和左心室扭转是DCM不良预后的强大独立预测因素。将它们纳入常规成像方案可增强风险分层，超越LVEF和LGE等传统指标。这些发现支持在DCM患者的综合评估中使用心肌变形分析。
